Sr Performance Auditor - FEP

Company Description

Why Wellmark: We are a mutual insurance company owned by our policy holders across Iowa and South Dakota, and we’ve built our reputation on over 80 years’ worth of trust. We are not motivated by profits. We are motivated by the well-being of our friends, family, and neighbors–our members. If you’re passionate about joining an organization working hard to put its members first, to provide best-in-class service, and one that is committed to sustainability and innovation, consider applying today! 

Learn more about our unique benefit offerings here. 

Want to know more? You can learn about life at Wellmark here.

Job Description

In this role the Sr Performance Adutitor will perform complex audits of core business processes, including claims payment, member benefits and enrollment, customer service inquiries, and provider contracts, with a focus on the Federal Employee Program (FEP) requirements. Responsible for demonstrating professional skepticism while performing intermediate-to-complex evaluations against program requirements to help leadership manage risk and identify and develop compensating controls. Support FEP external audit activities conducted by government and regulatory agencies and the Blue Cross Blue Shield Association requirements, including OIG/OPM. Must apply knowledge, skill, and experience over a broad range of technical program requirements and related business transaction processing functions.

Qualifications

Required:

• Bachelor's degree in accounting or related field, or equivalent work experience.
• Minimum of 4 years finance, auditing and/or business experience within the health insurance or related industry. Competent analytical skills, with the ability to analyze data and make recommendations
• Skilled attention to detail with the ability to complete tasks accurately and completely keeping business regulations and rules in mind.
• Practiced communication skills, both verbal and written.
• Ability to be flexible and adaptable while recommending changes to workflow to improve processes while guiding others through it. Practiced understanding of how business risk affects business strategy.
• Demonstrated interpersonal skills with the ability to build, maintain and leverage business relationships and consultation skills to drive results.
• Ability to coach and mentor others by providing guidance and feedback to help strengthen their knowledge and skills. Travel required up to 5%.

Preferred:

• Bachelor’s degree
• Audit/Compliance experience
• CPA, CIA, or similar certification, or willingness to work towards certification

Additional Information

a. Perform complex level audits (with a focus on FEP Programs) using statistical sampling audit methodologies; including coverage of core business transactions such as claims, membership & enrollment, benefit design, and system coding and edits.

b. Support the External Audit Lead for FEP-related audits conducted on behalf of government and regulatory agencies, including OIG/ OPM and the BCBSA. Coordinate and manage document preparations and pre-audit, analysis, research and development of audit responses, and negotiation for final audit reporting.

c. Support External Audit Lead in coordination of multiple audit projects, including issue identification and coordination of corrective action plans in accordance with regulatory requirements and federal guidelines (i.e., OPM, OIG, HHS, CMS, DOL, BCBSA).

d. Collaborate with External Audit Lead in discussions and negotiations for any audit issues with all levels of management or applicable stakeholders. Participate in exit conferences as appropriate and perform necessary follow-up to ensure issues are resolved effectively.

e. Compile and review populations of transactional data against established parameters for accuracy and completeness. Develop and document samples to be audited in accordance with audit requirements.

f. Compile and maintain audit documentation to support audit work performed, conclusions/issues identified and recommendations/ action plans. Develop desk level audit procedures, as necessary, for assigned audits.

g. Prepare reports summarizing audit findings and results based on established metrics and in accordance with FEP and BCBSA standards. Reporting includes preparing and submitting results to BCBSA on a quarterly basis. Will communicate results to leadership, including presentations as requested.

h. Maintain and continually improve understanding of Wellmark's business and business environment including compliance with laws and regulations, new products and services offered by Wellmark, organizational structure, corporate policies, and Wellmark's strategic direction.

i. Abide by the Standards for the Professional Practice of lnternal Auditing and the Code of Ethics.

j. Responsible for mentoring and coaching performance auditing staff by providing quality assurance feedback and subject matter expertise. Train junior level staff in audit process. Assist leadership with development and execution of the quality assurance process.

k. Serve as a liaison with BCBSA FEP audit staff and Sister Plans to identify and implement best practices for FEP-related audit activities.

l. Other duties as assigned.

An Equal Opportunity Employer

The policy of Wellmark Blue Cross Blue Shield is to recruit, hire, train and promote individuals in all job classifications without regard to race, color, religion, sex, national origin, age, veteran status, disability, sexual orientation, gender identity or any other characteristic protected by law.

Applicants requiring a reasonable accommodation due to a disability at any stage of the employment application process should contact us at [email protected]

Please inform us if you meet the definition of a "Covered DoD official".